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目的:观察抗人胸腺/淋巴细胞球蛋白(ATG/ALG)联合环孢素A(CSA)免疫抑制疗法治疗儿童重型再生障碍性贫血(SAA)的疗效与安全性。方法:回顾性分析我科2011年5月-2016年3月实施ATG治疗的37例SAA患儿的疗效及不良反应,其中男孩13例,女孩24例。治疗前口服肠道不吸收抗菌药物黄连素及阿莫西林肠道去污染治疗,口服大扶康预防真菌感染,碘伏擦浴清洁皮肤。兔源ATG(法国产)剂量为2.5~3.75mg/Kg/d,猪源ALG(中国产)20~30mg/Kg/d,均连用5天。治疗当天做皮试,即使用ATG/ALG1支的1/10量加在100ml生理盐水中静脉滴注1小时,观察是否发生全身反应或过敏反应。每日使用前使用抗组胺药如非那根0.5mg/Kg,同时经另一通道静脉同步滴注甲泼尼松龙(1~2mg/Kg/d)或氢化可的松(4mg/Kg/d)预防超敏反应及减轻变态反应。结果:ATG/ALG治疗总有效有效率57%(21/37)显效41.5%(15/37)。ATG/ALG不良反应观察结果(1)10例出现轻度过敏反应(2)14例发生血清病(3)13例发生感染(4)未发生ATG治疗相关死亡,(5)无复发病例。结论:ATG/ALG联合环孢素A治疗儿童SAA疗效显著且相对安全。
Objective: To observe the efficacy and safety of anti-human thymus / lymphocyte globulin (ATG / ALG) and cyclosporin A (CSA) immunosuppressive therapy in the treatment of pediatric severe aplastic anemia (SAA). Methods: A retrospective analysis of our department from May 2011 to March 2016 ATG treatment of 37 patients with SAA in children with side effects and adverse reactions, including 13 boys and 24 girls. Before treatment oral administration does not absorb antibacterial berberine and amoxicillin enteric decontamination treatment, oral prevention of fungal infections with Fukang, iodine rub sponge clean the skin. Rabbit ATG (France) dose of 2.5 ~ 3.75mg / Kg / d, pig source ALG (Chinese) 20 ~ 30mg / Kg / d, were used for 5 days. Skin test on the day of treatment, that is, using ATG / ALG1 1/10 volume plus 100ml saline intravenous infusion for 1 hour to observe whether the occurrence of systemic reactions or allergic reactions. Antihistamines such as fenotrione 0.5 mg / Kg were administered daily prior to use while intravenous infusion of methylprednisolone (1-2 mg / Kg / d) or hydrocortisone (4 mg / kg / d) Prevention of hypersensitivity and alleviating allergies. Results: The total effective rate of ATG / ALG was 57% (21/37) in 41.5% (15/37). ATG / ALG Adverse Effects Observations (1) 10 patients had mild allergic reaction (2) 14 patients had serological disease (3) 13 patients had infection (4) ATG-related deaths did not occur, (5) No recurrence. Conclusion: The combination of ATG / ALG and cyclosporine A is effective and safe for children with SAA.